PRESENTING
FELLOW

THE
CASE

A
newborn with respiratory distress and low lung volume

INITIAL
HISTORY

A 3-day old baby boy was transferred from a level 3 Neonatal intensive
care unit (NICU) for further evaluation. The presenting history consisted
of respiratory distress in the first few minutes of life. The baby was
cyanotic and hypotonic at 11 min of life. He improved with positive
pressure ventilation with bag and mask.

Perinatal
Hx
He was born by spontaneous vaginal delivery at 39 wks following an uneventful
pregnancy to east Indian parents. The antenatal ultrasound at 33 wks
showed bilateral talipes valgus. The birth weight was 3.275 kg. The
Apgar score was 6 at 1 min, 7 at 5 min and 8 at 10 min.

Physical
exam
No dysmorphism other than the talipes valgus was noted. Cardivascular
system, abdominal, and neurological examinations were normal. The respiratory
exam showed poor respiratory efforts, sub costal retractions, and nasal
flaring. Auscultation disclosed was fair breath sounds and a few inspiratory
crackles bilaterally. An inspiratory stridor was also noted. Pulse oximetry
showed a SaO2 of 67% in room air and 97% with an FIO2 of 1.00.